Doctors vs. Parents: Who Decides Right to Life?

Following surgery, Sabrina Martin's condition went south. And then, her family says, Children's Memorial Hermann Hospital set about arranging for her demise.

Even though the ethics committee never formally convened in Sabrina's case, activist organizations say Memorial Hermann and the doctors who work there have a quicker trigger finger than others when it comes to invoking the law.

Elizabeth Graham is the Director of Texas Right to Life, the only organization in the state on the call list provided to families in Texas who are notified that an ethics review is forthcoming. She says that while no formal statistical database exists, her group has received calls from 30 families throughout the state facing the ten-day law over the last three years, with nearly 17 percent coming from relatives with patients at Memorial Hermann in Houston.

"Memorial Hermann is the place from whom we receive the most frequent calls," Graham says. "They tend to rush towards running the ten-day clock."

Sabrina's former classmate, Davida Veal, moved in with her friend to help take care of her.
Daniel Kramer
Sabrina's former classmate, Davida Veal, moved in with her friend to help take care of her.

Graham does concede that because of Memorial Hermann's size and because the system serves such a large number of people, her statistics could be skewed.

Dr. Robert Fine of Baylor Healthcare Systems in Dallas, speaking on behalf of the Texas Medical Association, an organization representing 43,000 doctors and medical students, says it's not fair to label one hospital or another as having a quicker trigger.

"I just think that's absurd," he simply says, "and I think that's wrong."

Graham says another disturbing pattern she sees at Memorial Hermann is doctors entering orders not to resuscitate patients without first checking with or gaining consent from the families.

"It's a totally separate mechanism that accomplishes the same goal," says Graham, "but much quicker."

In Sabrina's case, doctors entered two orders not to resuscitate the teen, according to Sabrina's medical records.

"Hospitals routinely do that," Graham says. "In another case at Memorial Hermann, we were participating in an ethics committee process and the neurologist who had done brain surgery... he said that he put a DNR in the file. We asked, 'Did you consult with the patient's mother? Did you have any indication this is what the patient wanted?' And he said, "No, we do it all the time.' The doctor just decided to put a DNR on this patient. And I can think of two others right off the top of my head. And mind you, for all of this, these are only the ones who call us for help. There could be countless others."

Fine says that orders not to attempt resuscitation are almost always done in collaboration and with consent of the patient's family.

"I'd say it's that way 99.999 percent of the time," he says. However, "A doctor can write a [DNR] order on a patient if they feel that it is appropriate for the patient. No law prohibits that."

Fine concedes that because there is no database on the number of orders not to resuscitate that are entered or the number of times any one hospital convenes its ethics committee to decide whether to withdraw treatment, it's difficult to know which hospitals, if any, employ the laws more often than others.

"In most cases," he says, "because of the (privacy laws), we can't discuss them."

Graham says there is very little Texas residents can do to protect themselves if something goes wrong and they find their loved one's case in front of an ethics ­committee.

"The standard mantra has been to get the patient's wishes laid out in writing beforehand," she says. "But in Texas this means nothing because they can override it. It can be somewhat helpful, though, because if your wishes are spelled out, you have a stronger case if you have to go to court. What I would recommend is to call hospitals and ask what the hospital policies are."
_____________________

About a day after being told her daughter was in a coma, Lopez was sitting in the waiting room outside the intensive care unit when suddenly Lopez's stepmother came rushing over.

She told Lopez that she had been hanging around the hallway when a nurse came up and asked when Sabrina's funeral was going to be.

It took all the strength Lopez could muster not to break down and cry.

"I was so devastated and confused," says Lopez. "I didn't know if it was the truth or what. At this point, I didn't feel in good hands and I was starting to distrust the whole system completely."

This was only the beginning, Lopez and Murray say, of what became a horrifying pattern of hospital workers going behind their backs, talking to family members and trying to get them to yank the plug on Sabrina.

They claim that for days following Sabrina's second surgery, nurses and doctors were pulling extended family members aside, trying to encourage them to persuade Lopez and Murray to stop treatment, that it was the right thing to do.

"We ended up quarreling with family members who took the hospital's side," says Lopez. "It was chaos. Even now, it's still really hard and I don't talk to some of them anymore."

At one point, Lopez says, she called everyone who knew her daughter to tell them what was going on, including Lopez's former boyfriend living in Illinois. Daniel Martin, who showed up at the hospital, may be Sabrina's biological father, but Lopez and Painter say he has no legal rights and has had minimal involvement in Sabrina's life.

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